Running head: OCCUPATION IN CURRICULA

Determining How the Construct of Occupation is Addressed in Curricula

Kelsee Andersen
Tim Jensen
Ali Bullard
Phil Lamoreaux
Division of Occupational Therapy
University of Utah

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Introduction

Occupational therapy is described by the American Occupational Therapy Association

(AOTA) as a profession that helps people to do what they need and want to do in their everyday
lives (AOTA, n.d.). Historically, the profession was created based on the belief that engaging in
everyday activities improved the health and wellbeing of clients (Gordon, 2009). Therefore,
occupation has always been the defining characteristic that sets occupational therapy apart as a
profession. The importance of practice centered on occupation, often referred to as occupationbased practice, is advocated by occupational therapists and occupational scientists alike (Hooper,
2006; Hooper, Atler, & Wood, 2011; Hooper et al., 2013; Pierce, 1999; Price, 2003; Whiteford,
Townsend, & Hocking, 2000; Whiteford & Wilcock, 2001; Wilcock, 2005; Wood et al., 2000;
Yerxa, 1998).
Occupation-based practice should begin with occupation-centered education. Education
shapes the mind of the future practitioner, preparing him or her for contributing to and
developing the profession (Hooper et al., 2013; Sullivan & Rosin, 2008). Recently within the
field of occupational therapy, there has been a movement toward more occupation-based practice
(Price, 2003; Whiteford, Townsend, & Hocking, 2000) which necessitates a shift in the way
occupation is addressed in higher education at both the curricular and instructional levels
(Fiddler & Gillette, 2005; Hooper, 2006; Hooper et al., 2013; Pierce, 1999; Whiteford &
Wilcock, 2001; Wilcock, 2005; Wood et al., 2000; Yerxa, 1998). Occupation is a complex
concept for individuals to understand and a challenging construct to teach. Presently, a model
that assists educators in understanding how to teach and helps students understand the construct
of occupation does not exist. The current frame of reference, The Occupational Therapy Model
Curriculum Guide (AOTA, 2009), provides the educator with only an abstract structure on which

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to build their curriculum (Hooper, Atler, & Wood, 2011). Without a concrete guide, educators
lack direction regarding efficacious ways to teach occupation-based practice thus, students are
not developing a working understanding of the concept sufficient for viewing practice through
the lens of occupation (Hooper, Atler, & Wood, 2011).
In order to be occupation-based in the field, it is necessary for students to leave graduate
programs with an understanding of what occupation is, as well as how to utilize it in their
everyday practice (Hooper et al., 2013; Whiteford & Wilcock, 2001; Yerxa, 1998). By being
occupation-based, entry-level therapists will be able to sustain the life of the profession;
differentiate themselves from other healthcare professionals; and continue to improve the health
of their fellow human beings for decades to come (Whiteford & Wilcock, 2001; Wilcock, 2005;
Wood et al. 2000; Yerxa, 1998). This research project seeks to understand how the construct of
occupation is currently being addressed at both the curricular and instructional levels throughout
the country in an effort to eventually develop a manual that exemplifies how occupation is most
effectively taught.
Background
Occupation and Occupational Beings
The definition of occupation has sparked controversy throughout the history of the
profession since its conception. As is common in academia, concepts such as occupation are
given many definitions and the simplicity of the word becomes compromised (Wilcock,
2005). Despite the controversy, many professionals agree that occupation consists of the
following components: participation or doing, meaning to the person doing, goals, purpose, and
an activity that fulfills a particular role in ones life (Price, 2012). For the purposes of this paper,
occupation will be defined simply as the things that people do to occupy their time in meaningful

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ways (Fidler & Gillette, 2005; Hooper, 2006; Hooper et al., 2013; Whiteford, 2000; Whiteford &
Wilcock, 2001; Wood, Nielson, Humphry, Coppola, Baranek, & Rourk, 2000; Yerxa, 1998).
In our culture, many introductory conversations begin with a question such as what do
you do? Many people answer this question by stating their chosen vocation (Wilcock, 2005).
This response overlooks the complexity of the individual. A person is made up of much more
than their profession; they are a composition of biological systems and processes, personality
traits, and passions, to name a few (Yerxa, 1998). By understanding that humans are not defined
by one particular role or activity, it is possible to see the complexity of an individual. This
complexity calls for curriculum that teaches the student to look at an individual holistically, as
well as seeing them as an occupational being (Yerxa,1998).
Occupation and Health
In a 1998 survey conducted by Ann Wilcock, 60% of respondents associated engaging in
occupation with a sense of well-being. The results of this survey suggest that the layperson
defines health based on their ability to participate in meaningful activities (as cited in Wilcock,
2005). In stark contrast, the traditional medical model suggests that health is merely the absence
of disease or disability (Wilcock, 2005). Occupational therapists understand health to be a
complex interaction between the person, their environment, and their occupation (AOTA, 2008).
The foundation of occupational therapy was built upon the idea that enabling clients to engage in
occupation would improve health by mitigating the functional consequences of disease or
disability through the use of occupation as a therapeutic modality (Wilcock, 2005).In order for
occupation to be used effectively in practice, it must be instilled in practitioners during their
training. An occupation-based curriculum is the key to achieving this goal (Fiddler & Gillette,

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2005; Hooper, 2006; Hooper et al., 2013; Pierce, 1999; Whiteford & Wilcock, 2001; Wilcock,
2005; Wood et al., 2000; Yerxa, 1998).
Historical Timeline
To understand the context of this proposed study, it is necessary to review a timeline of
occupation and its role in the profession. When occupational therapy began in the early 1900s, it
was solely occupation-based. The late 1940s and 1950s brought a time of striving to fit into the
medical world, during which occupational therapy lost its occupational focus and thus lost its
identity (Kielhofner, 2009). During this time, occupational therapy had a reductionistic
emphasis, focusing on more medical definitions for function and dysfunction derived from
neurology and kinesiology. The 1970s ushered in a shift from positivist rationale to a more
interpretive science that has regard for power, diversity, temporality, and situatedness
(Whiteford, Townsend, & Hocking, et al., 2000, p. 62). In the late 1990s, several concerns were
raised about the profession of occupational therapy. Among those were concerns that the
majority of treatment time was being devoted to impairment-level procedures, which narrowed
the practice domain (Wood et al., 2000; Wilcock, 2005), and that clinical practice had become
separated from its unique occupation-based theoretical foundation (Whiteford & Wilcock, 2001;
Wood et al., 2000; Yerxa, 1998). Consequently, there was a call from within the profession to
reinstate occupation as the central construct in order to facilitate continued development of
occupational therapy as a profession with a unique and powerful contribution to the health of
society (Whiteford, Townsend, & Hocking, 2000; Whiteford & Wilcock, 2001; Wilcock, 2005;
Yerxa, 1998).
As the new millennium was approaching, occupational therapists and occupational
scientists alike felt strongly that in order to reflect the professions return to occupation as its

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core construct (and simultaneous movement away from a reductionistic, impairment-based
focus), a complementary curriculum redesign was imperative (Whiteford, Townsend, &
Hocking, 2000; Whiteford & Wilcock, 2001; Yerxa, 1998). Yerxa (1998) argued for occupationbased curricula stating that if occupation, and more importantly occupational beings, are at the
heart of practice then it follows that the education of future practitioners should reflect that and
occupation should be the core concept of curriculum (Hooper, 2006; Yerxa, 1998).
Yerxa (1998) was among the first to advocate for more education, suggesting that entrylevel therapists obtain a masters degree. She felt this would enable students to develop
professional reasoning skills required for practice. Shortly after her article was published, AOTA
passed Resolution J, a movement to mandate post-baccalaureate education for entry-level
practice (AOTA, 2007). With the new requirement, undergraduate programs transitioning into
graduate programs began contemplating curriculum redesign (Wood et al., 2000). The major
distinction between the two levels of higher education is the amount of critical thinking required.
During this same decade, theorists in the field of education proposed a new direction for higher
education, one focused on shaping the life of the mind for practice through the following
components of practical reasoning: gaining a greater sense of identity, community, and
responsibility, as well as mastering a body of knowledge (Sullivan & Rosin, 2008, p.xvii). As a
result of higher education, occupational therapy students should be able to master the construct
of occupation in preparation for practicing as clinicians with an occupation-based mindset
(Hooper et al. 2013).
After the turn of the century, AOTA came out with a model curriculum to support
programs in the process of redesigning their own curriculum (AOTA, 2009). The Model
Curriculum does not recommend specific courses or content, but instead gives elements of the

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curriculum that should be decided upon (Hooper, Atler, & Wood, 2011). Hooper, Atler, and
Wood found that the curriculum guide facilitated critical thinking, but could have provided more
support for conducting the actual process (Hooper, Atler, & Wood). Addressing one of the
limitations noticed, Hooper (2006) wrote an article about how occupation should be the core
construct of occupational therapy education. Since that time, individual curricula have been
studied; Wood (2000) and colleagues studied their own program, while Hooper (2006) examined
an exemplar program. Hooper (2006) concluded by arguing for more research concerning
occupation-based curricula, which leads directly into Phase I of this research project.
Methods
Phase one of this study focused on collecting data from 25 accredited OT/OTA schools
from across the nation. The schools were selected using a stratified randomization process. The
selected schools included 20 MOT programs and 5 OTA programs. The data collected from
these programs included: videos of classes being taught, artifacts (such as assignments, syllabi,
and curriculum designs), and interviews conducted with program directors. This data was
qualitatively analyzed utilizing Atlasti software to find themes throughout the data. The themes
were utilized to construct a survey for phase two as will be discussed further herein.
Design
Phase two of the study will analyze how schools around the nation implement occupation
in their curriculum. Phase two will utilize a mixed methods design. The designers of the study
postulate that conducting a survey is the most practical and efficient means to gain a greater
understanding of how occupation is implemented in curriculum. This method allows data from a
myriad of programs to be analyzed in the absence of the time and resources necessary for a more
invasive means of data collection.

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Although the process for phase three is not fully concrete, the final phase will focus on
determining exemplar programs through the results of phases one and two. Paramount examples
of implementing occupation into curriculum will be extracted from these programs and distilled
into an exemplar manual. The ultimate goal will be for this manual to provide a blueprint for
programs throughout the nation to look to when constructing more occupation-based curricula.
Participants
The desired participants will include all MOT/DOT/OTA faculty employed by accredited
teaching institutions in the United States (including territories). Faculty within programs
applying for accreditation or not currently accredited will not be included in this study. Emeritus
and adjunct faculty were included when listed on program websites, but not specially requested.
Instruments
The surveys will be designed using five themes and seven research questions as a
foundation. The themes were initially formed in an inductive process during phase one. The
research questions were formed in a similar manner during phase one. The research questions
will remain the same for the three phases of the study; they include:

How is occupation portrayed?

What topics are taught in relation to occupation?

How is occupation addressed at the curriculum level (i.e. what

infrastructure/supports/program culture are described as addressing curriculum)?

How is occupation addressed at the instructional level?

How are outcomes portrayed in relation to occupation? (i.e. Toward what ends is
occupation taught?)

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What Are Challenges to Addressing Occupation? (i.e. What are the challenges to
teaching occupation or to achieving learning outcomes related to occupation?)

The majority of the survey questions will be check all that apply while others will be formatted
using a likert scale or yes/no format. Two surveys will be sent out- one designed for program
directors (curricular survey) and another designed for faculty instructors (instructional survey).
The survey for program directors will cater to their additional knowledge of their
programs curriculum. The directors survey will include seven questions regarding whether the
curriculum conveys the importance of occupation to students, and in what ways occupation is
conveyed (e.g., through fieldwork, dialogue, organization of content, capstone experiences,
etc.). Outcome expectations, assessment methods, common challenges with teaching
occupation, and the predominant way occupation is conveyed will also be inquired about within
the curricular survey. The faculty survey will include more general questions about the day-today teaching of occupation in coursework. The survey will inquire about specific activities used
to teach occupation (e.g., small group discussions, lab activities, writing about occupation), what
the activity requires the students to do (e.g., examine their own occupations, define occupation,
assess occupational performance), and what students are expected to gain from these activities
and how those expectations are communicated and measured. The survey will conclude with an
open ended question concerning what the faculty members personal definition of occupation is.
Procedures
To gather contacts for these participants, student researchers will utilize the AOTA website to
locate all accredited OTA/MOT/DOT schools in the nation. Through these schools websites, the
students will locate facultys names and email addresses. When emails are not listed, the
institution will be contacted directly and asked for the email addresses after being provided with

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a general explanation of the study. The gathered addresses will be used to email a link to the
survey to each faculty member. There will be no time limit for completing the survey, but
respondents will be asked to submit the survey within one month of receipt. An email reminder
will be issued approximately and one week before the due date. The return rate will be
measured.
Data Analysis
Once returned, both surveys validity and reliability will be analyzed by a
statistician. Descriptive and inferential statistics will be used to interpret the results of the
surveys. The last two open-ended questions will be coded using the same data analysis manual as
phase one. The purpose of the analysis will be to seek a relationship between the survey results
and the findings of phase one. Phase ones findings will gain power if the quantitative findings
of phase two corroborate them. Phase twos purpose will be to examine how the construct of
occupation is currently taught in addition to finding exemplar schools leading into phase three
where a manual will be created.

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References

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